We read the recent report by Aguilar et al., who concluded that among patients with nosocomial peritonitis who are on continuous renal replacement therapy (CRRT), ceftolozane-tazobactam (C/T) at a dose of 3 g every 8 h is safe [1]. This finding was additional information following the notion that CRRT was an independent predictor of clinical failure when C/T was administered at 1.5 g every 8 h [2]. The Aguilar et al. protocol included a short infusion time, i.e., 1 h [1]. Previously described extended-infusion over 4 h was found to reach above the minimal inhibitory concentration (MIC), given that beta-lactam antibiotics exhibit time-dependent antibacterial activity [3]. This might prevent underdosing during CRRT [3]. Besides, the C/T elimination was explained by diffusion [1]. However, adsorption was not assessed. The acrylonitrile 69 Multiflow (AN-69-M) membrane, used in this study, has a lower adsorptive capacity compared with the AN69 surface-treated (AN69-ST) membrane, which is considered a highly adsorptive membrane (HAM). In a recent comparison of polysulphone versus AN-69-M for C/T extraction by CRRT in an ex vivo model [4], there was no difference in adsorption. In a case report, a continuous infusion (CI) of 6 g in 24 h of C/T was used in a cystic fibrosis patient with a multidrug-resistant (MDR) Pseudomonas aeruginosa and augmented renal clearance to optimize time-dependent antibacterial activity [5]. In this patient, therapeutic drug monitoring (TDM) confirmed adequate exposure [5]. CI and TDM are two critical parameters when using C/T for patients receiving CRRT especially when MICs of bacteria like MDR P. aeruginosa are considered very high.

中文翻译：

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在连续肾脏替代治疗期间优化头孢洛扎-他唑巴坦剂量：其他见解

我们阅读了 Aguilar 等人最近的报告，他们得出的结论是，在接受连续肾脏替代治疗 (CRRT) 的医院内腹膜炎患者中，每 8 小时 3 g 剂量的头孢洛扎-他唑巴坦 (C/T) 是安全的。 1]。这一发现是继 CRRT 是临床失败的独立预测因子后的额外信息，当 C/T 以 1.5 g 每 8 小时给药时 [2]。阿吉拉尔等人。方案包括较短的输注时间，即 1 小时 [1]。鉴于 β-内酰胺抗生素表现出时间依赖性抗菌活性 [3]，我们发现先前描述的 4 小时以上延长输注达到了最低抑菌浓度 (MIC) 以上。这可能会防止 CRRT [3] 期间剂量不足。此外，C/T 消除是通过扩散来解释的[1]。然而，没有评估吸附。本研究中使用的丙烯腈 69 Multiflow (AN-69-M) 膜与 AN69 表面处理 (AN69-ST) 膜相比具有较低的吸附能力，后者被认为是高吸附膜 (HAM)。最近在体外模型中对聚砜与 AN-69-M 进行 CRRT 提取 C/T 的比较 [4] 中，吸附没有差异。在一个病例报告中，在 24 小时 C/T 中连续输注 (CI) 6 g 用于患有多药耐药 (MDR) 铜绿假单胞菌和增强肾清除率的囊性纤维化患者，以优化时间依赖性抗菌活性。 5]。在该患者中，治疗药物监测 (TDM) 证实了充分暴露 [5]。CI 和 TDM 是对接受 CRRT 的患者使用 C/T 时的两个关键参数，尤其是当 MDR 铜绿假单胞菌等细菌的 MIC 被认为非常高时。